We present our experience with continuous local anesthetic infusion pumps following abdominoplasty to stress its cost benefit and safety. The prospective component of this institutional review board--approved study included all patients undergoing an abdominoplasty from January 1 to April 20, 2005. These patients received a survey on the day of surgery to be completed on a daily basis; the survey was collected at 1 week. The data gathered included presence of nausea, total number of hospital days, pain pills taken per day, and maximum pain scores on each day. We retrospectively collected the days of inpatient care and patient age and sex from January 1, 2003, to January 1, 2005.
Catheters were connected to a 4 cc/hour flow rate restrictor and then to a reservoir containing 300 ml of 0.375% bupivicaine. The catheters could not be connected to the reservoir without first connecting them to a flow rate restrictor, which prevented overdose. The patient received 360 mg over 24 hours. At 72 hours, the reservoir was depleted and the catheters were removed.
All patients from January 1 to April 20, 2005 completed the survey. The demographic data are listed in Table 1. Using the pooled continuous local anesthetic infusion pump data, there was no difference between the two groups based on age or sex.
Duration of hospital stay was 1.3 days shorter for the infusion pump group (0.45 days versus 1.8 days; 95% CI, 1 to 1.7 days), and this difference was statistically significantx (p = 0.000) (Fig. 1 and Table 2). After controlling for sex and treatment group, there was no significant correlation between age and duration of hospital stay (correlation coefficient = 0.02, p = 0.89).
Seventy-seven percent of the infusion pump patients reported resuming normal activity by postoperative day 3, the last day of local anesthetic infusion. All of the infusion pump patients resumed normal activity by 1 week.
The pain scores were rated on a visual analogue scale. On day 3, the average self-reported pain score was 5.5, whereas on day 4 it was 4.6. The average number of pain pills taken from day 3 to day 4 decreased from six to five, with a mode of six and four, respectively.
Nausea attributed to general anesthesia was reported by two patients in the immediate postoperative period. No patients had catheter-related wound infections.
All patients tolerated the pump and anesthetic. Fifty-nine percent of pump patients versus 0 percent of traditional patients were treated as outpatients. Three percent of pump patients compared with 60 percent of the traditional group remained in the hospital after 1 day. The 1.3-day shorter stay for the pump group was statistically significant. The cost benefit to this reduced stay is highlighted by Table 2.
The next question we addressed was whether patients would benefit from a longer infusion of the anesthetic. The pain scores and number of pills consumed decreased from day 3 to day 4, after the pump was empty. In addition, the majority of patients self-reported resuming normal activity by day 3. This indicates to us that prolonging the infusion was not necessary to adequately manage patients’ pain.
We have found the continuous local anesthetic infusion pump to be safe and cost-effective. Seventy-two hours appears to be a sufficient duration of bupivacaine infusion. The data gathered allow us to better counsel our patients.
Parul I. Patel, M.D.
Manish J. Patel, M.D.
Martin O’Toole, M.D.
Thomas Vanderlaan, M.D.
University of Southern California
Keck School of Medicine
Los Angeles, Calif.
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